REPUBLIC OF THE PHILIPPINES)

____________, ______________________) S.S.

SWORN STATEMENT

I, HANIFA MAE E. BATARA, of legal age, Filipino citizen, single and presently residing at MATALAO STO. NIÑO
CAGAYAN, after having been duly sworn to in accordance with law, hereby depose and state that:

1. I am a qualified participant in the Young Farmers Challenge Fund: Kabataang Agribiz Competitive Grant
Assistance Program (Young Farmers Challenge: Kabataang Agribiz Program) of the Department of
Agriculture (“DA”) and declared as provincial winner/kabataang agribiz program grantee entitled to
receive 50, 000.00;

2. I undertake to use the said prize money strictly for the implementation of my agribusiness venture (DUCK
LAYER: ITIK EGG PRODUCTION) submitted to the DA and to comply with the auditing rules and
regulations;

3. I obliged myself to open a separate bank account for the deposit of the said prize money which shall be
strictly used for the implementation of my agribusiness venture submitted to the DA;

4. I undertake to submit status reports of the implementation of my agribusiness venture to the DA concerned
offices (AMAS/AMADs) based on the following timelines:

i. Status report on the initial implementation of the project to be submitted one (1) month after the
release of the prize money;
ii. Quarterly progress report; and
iii. A terminal report one (1) year after the receipt of the prize money or immediately after complete
implementation of the Project (report shall contain evidence of the progress of venture, e.g.
pictures);

5. I shall immediately notify the concerned DA offices in case of any changes, delays, or any concern affecting
the implementation of my approved agribusiness venture;

6. I shall ensure availability of documents and other information relevant to the monitoring and evaluation of
my agribusiness venture and comply with the directives of the concerned DA offices;

7. I hereby declare that I am not an employee of the DA, nor a relative by affinity or consanguinity within the
fourth civil degree of an employee of the DA, its Regional Field Offices, Bureaus, Attached Agencies and
Corporation;

8. I further declare that I am not a recipient of any assistance or awards either in cash or in-kind amounting to
Php 50,000.00 and above from any project or program of the DA, its Regional Field Offices, Bureaus,
Attached Agencies and Corporation within one (1) year from the last start of the call for proposals for the
Young Farmers Challenge: Kabataang Agribiz Program;

9. I acknowledge that non-compliance to the above undertakings will result in my automatic disqualification
in the next level of competition (Regional).

I am executing this Sworn Statement to attest to the veracity of the foregoing statements and undertakings in
support of the implementation of the above-cited Project under the Young Farmers Challenge: Kabataang
Agribiz Program.

IN WITNESS WHEREOF, I have hereunto set my hand this day of September, 2021 in the town of Santo
Niñ o, Cagayan Philippines.

(HANIFA MAE E. BATARA)

Affiant
Government issued ID No.__
Issued on _________
Issued at _________

SUBSCRIBED AND SWORN to before me this _____________ day of ____, ____, at the town of ___________, Philippines,
the affiant exhibiting to me her Government issued ID written below her respective name.

Notary Public

Doc. No. _________

Page No. _________
Book No. _________
Series of 2021.